This document defines and discusses croup, a respiratory condition typically affecting children ages 3 months to 5 years. Croup is usually triggered by a viral infection of the upper airways, with symptoms including a barking cough, stridor, and difficulty breathing that worsens at night. While most cases are viral in nature, some bacterial causes are also noted. Diagnosis is usually clinical based on symptoms, though imaging may show narrowing of the trachea. Treatment focuses on supportive care, hydration, oxygen, steroids, and epinephrine to ease symptoms. Croup is generally self-limiting, with symptoms improving within a week.

1. PRESENTED BY:
A.PRIYADHARSHINI M.Sc(N),
LECTURER,
JAI INSTITUTE OF NURSING AND RESEARCH,
GWALIOR.

2. DEFINITION:
Croup (or laryngotracheobronchitis) is a
respiratory condition that is usually triggered by an
acute viral infection of the upper airway.

3. INCIDENCE:
Childrens are affected between 3 months to 5 years of
age with a peak during second year of life.
The incidence is higher in males and can occur
throughout the year with peaks in winter and late fall.
There may be an associated family history.

4. ETIOLOGY:
Viral causes:
Viral agents are more commonly implicated.
The parainfluenza virus type 1, 2 and 3 are the most
common etiologies.
Other viruses associated are influenza A and B,
adenovirus, respiratory synctial virus (RSV), and
Measles.

5. Bacterial causes:
Mycoplasma pneumoniae
 Corynebacterium diphtheriae
 Staphylococcus aureus
 Streptococcus pneumoniae
 Hemophilus influenzae and
Moraxella catarrhalis

6. CLINICAL FEATURES:
Initial symptoms- rhinnorhea, mild cough and low grade
fever.
“Barking" cough-The "barking" cough is often described as
resembling the call of a seal or sea lion.
 Stridor- The stridor is worsened by crying, and if it can be
heard at rest, it may indicate critical narrowing of the
airways.
 Hoarseness
Difficult breathing which usually worsens at night.
Other symptoms include fever, coryza (symptoms typical
of the common cold), and chest wall indrawing.

7. Diagnostic evaluation:
A frontal X-ray of the
neck- it may show a
characteristic narrowing
of the trachea, called
the steeple sign, because
of the subglottic
stenosis, which is similar
to a steeple in shape.
(inverted v shape)

8. CONTD..
Nasopharyngeal aspirate- Viral culture
WBC Count
Clinical diagnosis done
Other investigations are excluded to prevent
unnecessary agitation and thus improve the stress.

9. The Westley Score: Classification of croup
severity
Number of points assigned for this feature
Feature
0 1 2 3 4 5
Chest wall
None Mild Moderate Severe
retraction
With
Stridor None At rest
agitation
With
Cyanosis None At rest
agitation
Level of
Normal Disoriented
consciousness
Markedly
Air entry Normal Decreased
decreased

10. Scoring system:
A total score of ≤ 2 indicates mild croup.
A total score of 3–5 is classified as moderate croup.
A total score of 6–11 is severe croup.
A total score of ≥ 12 indicates impending respiratory
failure.
( The score ranges from 0-17)

11. TREATMENT:
Supportive care including intravenous fluids to
maintain hydration and oxygen inhalation to relieve
hypoxia has to be given.
A single dose of dexamethasone 0.6 mg/kg may
decrease the severity and duration of illness.
Inhalation of epinephrine may decrease the
symptoms of stridor and respiratory distress
immediately.
Antibiotics are not usually indicated.

12. COMPLICATIONS:
Extension of infectious process to other regions of the
respiratory tract, e.g. middle ear or pulmonary
parenchyma.
Bacterial tracheitis

13. PREVENTION:
Many cases of croup have been prevented
by immunization for influenza and diphtheria.

14. PROGNOSIS:
Viral croup is usually a self-limited disease, but can
very rarely result in death from respiratory failure .
Symptoms usually improve within two days, but may
last for up to seven days.

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